How a 19th century doctor’s hallucinations influenced our understanding of migraines today

Zayani Bhatt, 26 Jul 2017

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Born in England in 1838 to a father who also suffered from migraines, Hubert Airy’s illustrations of the hallucinations his headaches would cause are still the most influential illustrations of migraine auras.

Who was Hubert Airy?

Hubert Airy was a physician having studied medicine at Cambridge University. Following his graduation, Airy worked as a medical inspector for the English Local Government Board. He first became aware of his condition in 1854—when he noticed a small, blind spot that made it difficult to read.

He wrote, “Usually, after two or three hours close reading, especially if I have had insufficient exercise, I become aware that part of the letter I am looking at… is eclipsed by a dim cloud-spot.”

He described this spot as, “at first, it looked just like the spot which you see after having looked at the sun or some bright object.” The blind spot would continue to grow, taking on colour, and its edges becoming zigzagged. These auras would then lead to a migraine and accompanying nausea.

Airy published his findings in a paper titled On a distinct form of transient hemiopsia and presented it to the Royal Society of London on 17 February 1870. Eventually, the aura grew to take over all of his vision and his drawing of this was also published in the paper.

Frederick Lepore, an ophthalmological neurologist at Rutgers Robert Wood Johnson Medical School in New Jersey America, explains that this drawing has now become iconic.

“It’s so precise, like a series of time-lapse photographs,” expresses Lepore.

Hubert Airy’s 1870 diagram of his migraine aura looks familiar to many migraineurs today. Photo credit: The Royal Society/National Geographic

Airy was ahead of his time

Scientists today have noted how Airy’s drawings anticipate discoveries in neuroscience that were still decades in the future. Additionally, the man had realised that his hallucinations were a product of his brain, and not his eyes. He wrote, “all the causes that are found to lead to transient half-blindness point to the brain as the seat of disturbance.”

Airy also predicted that the way in which the eyes view the world or the visual map, can be directly mapped onto the primary visual cortex, although the scientific discovery of this was still another 100 years away.

Airy’s hallucinations have also made one privy to the idea that sights within the center of the eye are magnified, because the zigzags around his blind spots were more dense in the centre of his eye.

“Airy’s drawing fits beautifully with our modern conception of how the visual cortex is organized,” Lepore said.

Before Airy, other scientists also shared their experience of migraines

Hubert’s father, George, was one such scientist. Although he did not suffer from migraines, he did experience hallucinations. He had also published a sketch of his own zigzag hallucinations five years before his son.

George, Hubert Airy’s father, also saw zigzag hallucinations—but, they didn’t precede a headache for the elder Airy. Photo credit: The Royal Society/National Geographic

A German neurologist published a basic sketch in 1845 and French neurologist Joseph Babinski drew particularly colourful ones.

Airy’s paper which he published when he was just 31, was his sole contribution to the field—but it has stood the test of time. Lepore for example, showed them to 100 of his patients who suffer from the condition. 48 of them recognised it instantly.

Airy did however contribute much to evolutionary medicine. He had well-developed ideas on pathogen-host co-evolution; but unfortunately they were unnoticed before his impact could be noted in history.

In a paper titled On infection considered from a Darwinian point of view, he explained, “As the human syncrasy varies in the direction of insusceptibility, so the parastic microzyme will, step for step, attain new virulence, and… as long as man and microzyme are allowed to meet, I see no possibility of a cessation of the process.” MIMS